Provider Demographics
NPI:1639210693
Name:YKAO-DAMAN, BASIMA YKAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASIMA
Middle Name:YKAO
Last Name:YKAO-DAMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23528 JOHN R. RD.
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030
Mailing Address - Country:US
Mailing Address - Phone:248-629-7540
Mailing Address - Fax:248-629-7541
Practice Address - Street 1:23528 JOHN R. RD.
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030
Practice Address - Country:US
Practice Address - Phone:248-629-7540
Practice Address - Fax:248-629-7541
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4612414Medicaid